Comparing the Long-term Outcomes of Coronary Artery Bypass Grafting (CABG) vs. Percutaneous Coronary Intervention (PCI) in Patients with Multivessel Disease- A Systematic Review and Meta-Analysis.

Abstract

Introduction: Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are standard treatments for Multivessel Coronary Artery Disease (MVD). Their long-term comparative effectiveness remains debated.

Method: A systematic review and meta-analysis of randomized and observational studies was conducted, including patients with MVD followed for ≥5 years. Data were pooled using randomor fixed-effects models, depending on the level of heterogeneity.

Results: Thirteen studies met the inclusion criteria. CABG was associated with reduced all-cause mortality (RR 0.82, 95% CI 0.72-0.91) and fewer repeat revascularizations (RR 1.98, 95% CI 1.74-2.26) compared with PCI. Stroke risk was slightly higher after CABG.

Discussion: Findings suggest CABG provides superior survival and event reduction in long-term follow-up, particularly in higher-risk subgroups. However, the modestly increased stroke risk highlights the need for individualized decision-making, taking into account patient comorbidities, anatomy, and surgical suitability.

Conclusion: CABG offers long-term survival and durability advantages over PCI in MVD, while PCI remains suitable for patients with lower-risk anatomy or when surgery is contraindicated.